
Over the past five years, as margin pressure has increased and cost reduction efforts have taken center stage, companies have scanned the enterprise with a fine-tooth comb, looking for opportunities to regain margin. As more data has become available specifically highlighting the magnitude of potential losses from revenue leakage in the channel, this issue has quickly risen on corporate radar screens.
From 2004 to early 2008, the market went through a prolonged education phase, with most companies working to increase their understanding of the problem and accumulate information to construct the necessary business case to justify further IT investment (the average chargeback system is more than six years old). Given this is a nine-figure problem for many companies, revenue leakage as a topic has recently become a CFO-level issue. CFO awareness was actually the best development possible as it has given many revenue management teams the C-level backing they needed to secure funding for IT system upgrades. Much of 2008 and 2009 acted as an evaluation phase, as companies reviewed their existing capabilities and evaluated newer products available on the market. Only recently has the market now begun moving toward a purchase and implementation phase, though this has been somewhat slowed due to the recent economic recession. However, as budgets loosen, this purchasing phase will likely continue for the next 3–4 years, until most of the industry has upgraded its revenue management IT. Unlike CRM and ERP, revenue management systems (such as chargebacks, rebates, and contract management) are an area in which companies are not completely averse to a rip-and-replace strategy, since most solutions today are sold in modular fashion, are platform independent, and come pre-built with streamlined integration to SAP and Oracle back-end infrastructures.
Three years ago, IDC Health Insights published a report that provided the first quantitative breakdown of revenue leakage in the industry. Since then, industry focus on reducing leakage has risen substantially, and life sciences companies are searching for answers to questions like: What is causing this leakage? Where is this money going? How can we reduce revenue leakage? To answer these questions, Health Industry Insights recently surveyed 151 industry leaders and conducted in-depth interviews with 23 pharmaceutical companies to identify channel leakage points and quantify revenue lost. In addition to updated quantification surrounding chargebacks, reverse chargebacks, duplicate chargebacks, product returns, and concealed shortages, new leakage categories have been added surrounding managed care and Medicaid rebates. In total, the study found that revenue leakage causes pharmaceutical companies to lose approximately 4.4% of overall revenue on an annual basis. For 2009, most forecasts predict U.S. pharma sales will be roughly $252 billion. That means as an industry, pharma manufacturers will collectively lose approximately $11 billion through channel inefficiencies. That's equivalent to total revenue for a top 20 pharma simply disappearing each year.
The report, titled Revenue Leakage: Pharma's $11 Billion Problem will be published next week and will be available on our website. Members of the life sciences community will also have the opportunity to see the full detailed results presented in person at IDC Health Insights conference taking place on February 23-24, in Boston, MA. Conference attendance is free for qualified registrants. For more information, go to: http://lifesciencesinsight.com/
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Eric - you are right that many pharmacos are seeking to implement strategies to reduce revenue leakage. One of the answers to the question you pose, 'What is causing this leakage?' has to do with managed care (payer) controls and patient behavior. For example, some pharmacos that I work with are looking at 'Unfilled Rxs' or (URxs) and categorizing URxs as Rx leakage (Sales/Revenue Leakage). They look at how many Rx claims are rejected by the plans, how many Rxs are abandoned by patients (meaning the Rxs were taken to the pharmacy, were approved by the payer, and then never filled by the patient, primarily due to co-pay price sensitivity), and how many Rxs were switched to a generic or competing brand. And, then they look at patient compliance and adherence to determine the % of Rxs that are not used, refilled, etc. to truly determine the 'lost' revenue opportunity they are facing at the point-of-sale.
I have seen the % of URxs be as high as 19% for some large brands, and this number continues to increase for many brands due to rising co-pays, the recession, and much stricter controls enforced by health plans. Many of these same pharmacos are even starting to analyze this down to the regional level to determine the true influence that payers and patients have on Rx leakage at the local level to better determine what types of resources and programs to deploy to help reduce the URx rate (or Rx leakage).
Has this type of Revenue Leakage been brought up or discussed by the pharmacos you speak with?
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Hi Seth,
The problem you describe for branded pharmas regarding price sensitivity and generic competition at the point-of-sale is widespread. This "leakage" due to last minute substitution, though not part of our recent study, is another significant area of loss for pharmas, and has grown in the last few economic down years. I have seen companies analyzing payer/formulary influence and competitive pricing to better strategize on sales/marketing aimed at the pharmacy. The pharmacy, being the final decision point for the consumer, is definitely becoming a higher priority target for pharmas, even more so now that physician availability for detailing is quickly diminishing. I'd expect to see this trend of sales/marketing attention towards the pharmacy continue to grow, especially given the patent cliff the industry continues to face.
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I also see pharma beginning to focus more of their attention on the Payers as pharma continues to refine and develop more effective contracting strategies, target only those prescribers that are less impacted by payer influence, and deploy co-pay cards to those prescribers who have more price sensitive patients.
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Agreed. I've seen that practice spreading firsthand. Unable to dodge the seasonal bug, I myself was sick with bronchitis over the holidays. I was expecting the standard Z-Pack prescription, but my doctor prescribed another brand that he felt worked better and handed me a coupon to cover the co-pay, making it essentially free. Personally, I don't think I fit into the segment categorized as "overly price sensitive", especially when I'm sick and I would pay just about anything to feel better.
Based on this experience, and further supported by conversations I've had with pharma clients, I believe that more pharmas are trying this method to convert consumers across brands. But the reality is that it is left in the physician's hands to decide who to give the coupons to, and most physicians will just hand them out at random, and not necessarily cherry pick the patients that pharma's would prefer receive the coupons to maximize their impact. Also, although the prescription worked fine, I don't think i'd be any more inclined to request this brand of drug next time I'm sick. So while it's an increasing method of pharma marketing, I think the jury is still out on how effective it will be in influencing market share.
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